Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC1215 | HI |
N | 111NP0017X | Pediatric Chiropractor | DC1215 | HI |
N | 111NS0005X | Chiropractic Sports Physician | DC1215 | HI |
NPI | 1417233461 |
---|---|
Provider Name | Dr. Richard Tyler Dennis |
First Address | Laie, HI 96762-0393 |
Second Address | Hauula, HI 96717-9641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2011 |
Last Update Date | 24/01/2012 |